On Reproductive Health
- climatehealthnurse
- Feb 17
- 10 min read
Updated: Apr 20
Personal Thoughts
As a woman of childbearing age, I've always planned to have kids and try to conceive with my partner after getting married. I finished high school, college, and grad school, and chose to get settled in my career before even thinking about getting pregnant. Going through all these life events just so happened to bring me to 2025, a year that coincides with Donald J. Trump becoming president of the United States again. Here's why I'm worried for myself and many others.
I believe every person with child-bearing capacity has right to decide when they want to get pregnant. In the case that they do get pregnant, they should have options for keeping the pregnancy to raise the child, or discuss surrogacy and adoption. They should also have the option of abortion, presented by a medically trained professional capable of counseling on pregnancy outcomes and health risks.
Many people are against abortion on moral grounds. I too, feel uncomfortable when someone wants to end a healthy pregnancy with no reason besides the fact that the pregnant person just doesn’t want to have the baby. However, it is fully within the rights of the person carrying the pregnancy to decide what should happen to their body, since pregnancy is a high-risk medical condition that impacts people's health in countless ways. From gestational diabetes, to preeclampsia, to the increased risk of deep vein thromboses, pregnancy is already a physiologically compromising condition.
It's also important to analyze the factors that lead up to an unwanted pregnancy. How did this person get pregnant, and how much control did they have over the situation? Did the person's sexual partner secretly take off the condom (a.k.a., "stealthing," per Urban Dictionary)? Did someone rape this person? Does this person have birth control, or know how it works? Did this person learn anything about sex and pregnancy at school? Ironically, the same organizations that oppose abortion from a moral standpoint also stand against comprehensive sex education and the expansion of birth control access that gives everyone information on how to avoid unwanted pregnancy and ultimately, an untimely abortion.
For example, a 2011 peer-reviewed study by Stanger-Hall and Hall analyzing national data about sex education laws or policies shows that abstinence-only education is correlated with an increase in teenage pregnancy and birth rates. The data was obtained from 2005 and compares outcomes based on what kind of sex education was chosen at the state level when there were two types of sex ed available - comprehensive evidence-based sex ed, and abstinence-first sex ed.
I believe that every pregnant person, including myself at some point, should have access to unrestricted, comprehensive obstetric care, including prompt medical action to rescue the pregnant person if their life is in danger, even if it means the fetus will not survive. Abortion restrictions add unnecessary regulations that govern how doctors, nurses, and other healthcare providers in obstetrics, emergency medicine, and other specialties are allowed to treat pregnant people in life-threatening, time-sensitive conditions.
Case Studies
Take the recent case of Navaeh Crain, an 18-year-old pregnant Christian woman living in Texas who was about to host a baby shower with her mom when she started to feel unwell. In summary, she died of sepsis and disseminated intravascular coagulation (DIC) from a miscarriage. She must have been in a lot of pain from a bacterial infection that spread to her bloodstream, and went into organ failure before dying. She went to three different hospital emergency rooms and appropriate medical care was delayed during the clinical course, likely due to the policy implications of Texas Law, which promises prison time for anyone who assists in ending a fetal heartbeat. Some netizens say that the medical negligence that Crain faced had nothing to do with her pregnancy, alleging that doctors and healthcare staff could have done further testing to save her, but the truth is murkier - especially when abortion as a potential option for life-saving treatment has been blacklisted.
Most states are governed by the Emergency Medical Treatment and Labor Act (EMTALA), because this is a federal law in the United States. It requires that anyone seeking emergency care in the emergency department cannot be turned away because they're unable to pay for their medical care. If the hospital doesn't have the equipment or personnel to treat the condition, they must provide a transfer of care to another hospital that can actually help the patient. This federal law has always included provisions for pregnant women, and allowed doctors to perform emergency abortions if the woman's life was in danger... until recently.
The Biden administration issued a guidance supporting the stabilization and treatment of pregnant women even if that includes abortion to save a life. However, the state of Texas sued the administration, claiming that this would “transform every emergency room in the country into a walk-in abortion clinic.” In January 2024, Texas eventually won, so the injunction that held the state’s abortion ban over EMTALA stayed in place. That is to say, in Texas, the abortion ban overrides the federal law to provide care to pregnant people who are in distress and need life-saving treatment in the emergency room. This makes it against the law for doctors and advanced care providers to terminate a pregnancy in a pregnant person who is slowly dying, unless it is abundantly clear from medical judgment that the fetus has no chance of survival. Details are actually available here at the Texas Attorney General’s official website.
Supporters of abortion bans say that the goal is to outlaw abortion, while also protecting the health of the mother in exceptional medical cases. However, in states like Texas with severely restrictive abortion bans, it's unclear what protections are in place to guarantee these exceptions hold up in court when even EMTALA cannot be followed.
Take the case of Kate Cox, a woman from Dallas, Texas, for example. She had a wanted pregnancy, and was devastated to learn that the fetus was diagnosed with full trisomy 18, a genetic condition in which babies are born with heart, lung, and kidney abnormalities and rarely live past their 1st birthday. Babies born with such conditions suffer greatly after birth, and need complex medical care for life. For this reason, she was petitioning the state so she could get an abortion, and a Travis County district judge had permitted her to do so.
According to ProPublica, Texas Attorney General Ken Paxton stepped up to halt this lower court’s order, and personally sent a letter to three hospitals threatening to prosecute staff if they allowed her to have an abortion at their facilities. Paxton won, so Kate was forced to leave the state of Texas to get an abortion, even in this extenuating medical circumstance.
The Federal Government and the Bigger Picture
One important takeaway is that this whole shebang in Texas was a direct result of Donald J. Trump’s actions. As much as the media loves to portray him as an idiot, he played a huge role in packing many judicial courts with judges and justices who favored ultra-right wing interpretations of the law. From lower courts to the Supreme Court, these folks did not broadly support the views of the people. This allowed the Supreme Court to successfully overturn Roe vs. Wade in 2022, ruling that there is no federal constitutional right to abortion. Once abortion became a states' rights issue, Texas adopted the most restrictive abortion ban in the U.S., also in 2022, which resulted in these scenarios in the case studies above. These are cisgender, young, white women with wanted pregnancies too, meaning it's just the tip of the iceberg. There are dozens more cases of women of color, trans people, domestic violence victims suffering from restrictive abortion law with fewer rights, sympathy, and often financial and family support. I might as well throw in that the people who are obsessed with justifying abortion being "up to the states" don't seem to mention or care about federalism in the context of marijuana, immigration policy, vehicular emissions, or other examples of federal vs. state law. In other words, "that's not very 'states' rights' of them, either."
With Trump's close ties to the writers of Project 2025, the detailed, ultra-conservative policy proposal on how to bring "Christian values" back to America, we are nervous what's next on the chopping block in the field of reproductive healthcare and family planning. Some states like Alabama have outlawed in vitro fertilization for parents who are unable to have a baby naturally due to struggles with infertility. There are already movements to limit and ban contraceptive access, by making sure birth control methods are not covered by health insurance. And text from the 900+ page outline of Project 2025 contains specific language recommending a ban on ella, the Plan B (day-after pill) equivalent for folks who weigh more than 165 pounds, because Plan B as a hormonal medication won't work as effectively for plus-size people.
Globally, restrictive abortion laws coincide with increased rates of abortion, and a huge increase in maternal mortality. The U.S. is certainly taking a step back with the reversal of Roe v. Wade, and whatever looms on the horizon. At a time when many young adults are already reconsidering starting a family for climate change-related reasons, the promise of more restrictions on reproductive healthcare is another slap in the face.
Working in Healthcare
As a healthcare provider, I learned in school that every note you write is scrutinized as a legal document now and in the future if you ever get sued, subpoenaed, or taken to court. So you can imagine the amount of tiptoeing you do, even if a patient has already made the decision to get an abortion, of documenting stuff when you are explaining to them the difference between a medication and surgical abortion. You have to be so vague. I'll never forget an encounter that stuck with me - A Women's Health Nurse Practitioner I was shadowing asked for the name of the OB/GYN provider in a state that has been unfriendly to abortion, and the person hesitated for 5 whole seconds before cautiously and flatly stating her first name. The striking down of Roe vs. Wade now makes us hesitant to collaborate with other health professionals in an open, trustworthy way, and limits information sharing, even if it's for the purpose of wanting to know if our patient is safe and doing okay.
From the patient's perspective, there are also plenty of hoops to jump through. I can't speak to the process in other countries, but in the U.S., many patients I work with need to see a Primary Care or Urgent Care provide first, where they would then receive a consultation about other options besides abortion and on how staff don't provide the services in-house, before being referred to another specialty center to schedule another consultation, and then finally, a procedural appointment to receive an abortion. Sometimes, insurance already does not cover the abortion procedure, regardless of whether a primary care provider writes a Gynecology referral or not.
I have not worked that long - only slightly over a year. But I've spoken to patients while working telephone triage, educating them on the possibilities of early fetal demise, late fetal demise, and ectopic pregnancy already. Miscarriage is far from the marginal case, as it's estimated that about 20% of all pregnancies end in miscarriage, at least in the United States from 1990 to 2011. And miscarriage can be deadly, resulting in blood loss, infection, and a whole slew of other issues in which the pregnant person's health is threatened, even when the fetus' heart is still beating.
I have seen rhetoric stating that doctors, nurses, midwives and other hospital staff "refuse to help" dying pregnant women - but what choice do we have if this means we're willingly committing a crime? Who willingly enters a field and takes an oath to "do no harm," goes through school and training for years, and is happy to let a patient die because the attorney general of the state might show up and send you to prison? Even if you're a healthcare provider without a shred of integrity, losing a license and going to prison over violating a state abortion ban means wasting hundreds of thousands of dollars spent on medical education when you could have chosen to study something else. The cards are stacked against us, and I'm concerned that rates of physical and verbal abuse against Emergency Room staff and the rest of healthcare providers will only increase, as lawmakers who know nothing about medicine continue to be the root of our problems pertaining to needless suffering and death. Restrictive abortion law is terrible for healthcare providers who know the science, the procedures, and what they're doing. It represents a frightening growing trend of anti-science attitudes taking precedence over those who have studied fields of medicine and other sciences. I anticipate that aspiring doctors wanting to go into obstetrics will either change their career path or move to different states that don't criminalize a large part of the healthcare they provide. And this will impact everyone.
What Now?
I still want to have a baby, but only if it can be done in a way that doesn't jeopardize my life or ability to receive supportive care through a medical disaster. As an individual, and hopefully a future mom, I'm speaking with people in my circle who have recently given birth to ask them how their experiences were, and what they'd be worried about for me. Here are some basic things you can do based on your capacity and situation:
Continue to talk, plan, and strategize with your friends safely in real life, and not just online
Pay attention to state news on reproductive health restrictions, including abortion bans, what gestational age they take effect, and allowances for pregnancy termination in the case that the pregnant person's life is endangered
Save, bookmark, and download reliable resources and information on contraception and how to access meds like Plan B (shelf-life 4 years), mifepristone (shelf-life 5 years) & misoprostol (shelf-life 2 years)
Resources:
Planned Parenthood - for all things family planning, sex education, contraception, and abortion
Reproductive Health Access Project (RHAP) - for clinicians working to expanding access on reproductive healthcare
PRJKT RUBY - for low-cost online birth control
Abortion Finder
I Need An A
Plan C Pills - Abortion pills by mail in every state (USA)
Repro Legal Helpline - for state-specific legal support in regards to abortion www.reprolegalhelpline.org
Reproductive Autonomy - a master list of even more resources
*Aid Access - For information and access to abortion and miscarriage care, wherever you are within the 50 states of the USA. Informacion sobre tratamiento de un aborto disponible en español también.
*Women Help Women - pregnancy calculator, contraceptives, and abortion pills. Available in a variety of languages
*Just The Pill
*Fun Fact: The sites with an asterisk were blocked or suspended from Instagram by Meta in the first few weeks of the Trump administration.
Future Reading:
I wasn't going to let us get too far away from the connection between anthropogenic climate change and unwanted pregnancy, so here we are.
